在加纳北部采用跨部门方法探索与参与治疗行为相关的社会生态因素。

IF 2 Q3 HEALTH POLICY & SERVICES Journal of Cancer Policy Pub Date : 2024-07-25 DOI:10.1016/j.jcpo.2024.100497
Chloe Tuck , Laura Gray , Hamza Suraj , Abdul-Rashid Timtoni Iddrisu , Tampuri Rahman Abane , Richmond Aryeetey , Braimah Abubakari Baba , Robert Akparibo , Richard Cooper
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引用次数: 0

摘要

背景:癌症给全球带来了日益沉重的负担,尤其是在加纳等非洲国家,由于社会、文化和经济等多方面的原因,癌症治疗的辍学率很高。人们对接受治疗的行为模式知之甚少,尤其是在加纳北部,本研究就是为了探讨这一问题:通过跨部门合作,我们提取并临床验证了塔马利教学医院的癌症患者病历。我们对这些记录进行了描述性分析和多变量逻辑回归分析。我们还采用了治疗映射流程,以突出数据收集中的挑战。对于大量缺失数据,采用了链式方程进行多重估算。对缺失数据的影响进行了敏感性分析:结果:即使考虑到数据缺失造成的不确定性,治疗退出率也很高,只有 27% 的患者完全接受了治疗。所有癌症(包括加纳国家医疗保险计划覆盖的癌症)的辍治率都很高。多变量逻辑回归显示,社会、健康状况和系统性因素会影响治疗的参与度,直至完成治疗。肝癌、卵巢癌、结直肠癌、胃癌、膀胱癌、食道癌、头颈部和皮肤癌以及软组织肉瘤的数据缺失率较高,这限制了模型的拟合:结论:辍治是加纳北部的一个关键问题。由于治疗路径的动态性、复杂性和分散性,数据缺失率很高。未来的研究需要了解数据记录方面的复杂挑战。政策总结:辍治是一个相关问题,政策制定者应努力解决。需要与参与癌症治疗和数据收集的利益相关者进行进一步讨论,以更好地了解在当地环境下常规数据收集所面临的挑战。这将有助于制定政策,以应对多种相互交织的健康和社会因素对完成治疗的影响。
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A cross-sector approach to explore socio-ecological associations with treatment engagement behaviours in Northern Ghana

Background

Cancer presents a growing global burden, not least in African countries such as Ghana where high cancer treatment dropouts has been identified due to numerous social, cultural and financial reasons. There is little understanding regarding patterns of treatment access behaviour, especially in Northern Ghana, which this study was designed to explore.

Methods

Through cross-sector collaboration, we extracted and clinically validated cancer patient records available in the Tamale Teaching Hospital. These were analysed descriptively and through multi-variate logistic regression. A treatment mapping process was also applied to highlight challenges in data collection. Multiple imputation with chained equations was conducted for high levels of missing data. Sensitivity analysis was applied to assess the impact of missing data.

Results

Treatment drop-out was high even when uncertainty due to missing data was accounted for, and only 27 % of patients completely engaged with treatment. High drop-out was found for all cancers including those covered by the Ghana National Health Insurance scheme. Multi-variate logistic regression revealed that social, health condition and systemic factors influence treatment engagement until completion. High missing data was observed for liver, ovarian, colorectal, gastric, bladder, oesophageal and head and neck and skin cancers, and soft tissue sarcomas, which limited model fitting.

Conclusion

Treatment drop-out is a critical issue in Northern Ghana. There was high missing data due to the dynamic, complex and decentralised treatment pathway. Future studies are needed to understand the complex challenges in data recording.

Policy summary

Treatment drop out is a pertinent issue that policy makers should look to address. Further discussion with stakeholders involved in cancer treatment and data collection is required to better understand challenges to routine data collection in the local setting. This will allow policy to be designed to cater for the impact of multiple intersecting health and social factors on treatment completion.

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来源期刊
Journal of Cancer Policy
Journal of Cancer Policy Medicine-Health Policy
CiteScore
2.40
自引率
7.70%
发文量
47
审稿时长
65 days
期刊最新文献
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